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RETURN THIS FORM TO:
Service Alberta
Consumer Services Division
3rd Floor, 10155 102 Street
EDMONTON AB T5J 4L4
Fax No.: (780) 427-3033
Print Form
Cooperatives Act
Sections 370(2) and 378(1)
PLEASE PRINT OR TYPE
1.
Name of Cooperative 2. Alberta Corporate Access Number
(as noted on registration documents)
3.
New Address of the Head Office
(This should be the registered address of the cooperative.)
Address Street City /Town Province
4. Telephone Number
(include area code)
Facsimile Number
(include area code)
5. Email Address
(if applicable)
5.
Effective Date of Change
Date (mm/dd/yyyy)
Postal Code
Signature of Authorized Person Title (please PRINT) Date
(mm/dd/yyyy)
Name (please PRINT) Daytime Telephone Number
(include area code)
This information is being collected for the purposes of corporate registry records in accordance with the Cooperatives Act. Questions about the collection of this information can be directed to the Freedom of Information and Protection of Privacy Coordinator for the Alberta Government, Box 3140, Edmonton, Alberta T5J 2G7, (780) 427-5210.
SA0104 (2002/03)
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